Determinants of Quality of Life in Elderly Adults with Diabetes

个人描述(申请人提供)：我是一名普通内科医生和研究员，长期目标是成为一名独立调查员，专注于患有复杂慢性病的老年人。为了完成这一目标，我正在寻求更多的课程、培训和研究经验。糖尿病是一种复杂的慢性疾病，对老年人的影响不成比例，并与较差的生活质量有关。最近的指南建议，老年糖尿病患者的护理应该包括筛查和管理老年综合征，如跌倒、尿失禁、痴呆、抑郁、慢性疼痛和虚弱。然而，这些建议几乎没有正当理由。传统糖尿病并发症、老年综合征和生活质量之间可能存在复杂的相互关系。例如，足部溃疡和跌倒都可能导致较差的生活质量；然而，足部溃疡可能导致步态不稳定和跌倒，这将导致较低的生活质量。此外，可能还有一些老年糖尿病患者的亚组，对他们来说，糖尿病并发症和老年综合征尤其与生活质量差有关。生活质量也是由健康经济学家用被称为健康状态效用值的量化价值来衡量的。开发老年患者的传统糖尿病并发症和老年综合征的效用价值，将有助于对针对这些医疗问题的干预措施进行成本效益分析。考虑糖尿病患者的老年综合征可能会改变传统的血糖管理和整体糖尿病护理方法，并帮助提供者优先照顾这些复杂的患者。具体目标：1)研究老年综合征、传统糖尿病并发症和生活质量之间的复杂相互关系；2)确定生活质量低下的特别高风险的老年糖尿病患者的社会人口亚群，并评估老年综合征和/或糖尿病并发症的贡献；3)量化老年糖尿病患者中特定老年综合征和糖尿病相关并发症的健康状况效用价值。这些目标将通过使用多元线性回归建模和基于算法的将每个老年综合征和糖尿病并发症的生活质量分数转换为健康状态效用值的算法，对60岁以上的成年糖尿病患者的特征良好的多种族队列的现有数据进行严格分析来实现。这项研究建议将填补有关糖尿病对老年人生活质量影响的医学知识的巨大空白。此外，老年糖尿病患者的老年综合征和糖尿病并发症的健康状态效用值将允许对未来的治疗和计划进行成本效益分析。在此奖学金期间完成这些目标对于我发展成为老年糖尿病和护理优先领域的研究人员的长期目标也是至关重要的。 公共卫生相关性：糖尿病对老年患者的影响不成比例，是一种昂贵的复杂慢性病。老年糖尿病人群是异质性的，是糖尿病患者中增长最快的年龄段。然而，关于他们的护理方面的研究很少。由于糖尿病在老年人群中的高患病率，确定影响老年糖尿病患者生活质量的因素可能具有广泛的临床意义。此外，了解传统糖尿病并发症和老年综合征对生活质量的影响可以帮助医生优先考虑老年糖尿病患者的复杂医疗问题。开发糖尿病并发症和老年综合征的效用评分将允许对未来的治疗和计划进行成本效益和成本效用分析。

DESCRIPTION (provided by applicant): I am a general internist and research fellow with a long-term goal of becoming an independent investigator with a focus on the elderly with complex chronic diseases. To complete this goal, I am seeking additional coursework, training, and research experience. Diabetes is a complex chronic disease that disproportionately affects the elderly and is associated with worse quality of life. Recent guidelines suggest that the care of elderly diabetes patients should include screening and managing geriatric syndromes like falls, urinary incontinence, dementia, depression, chronic pain, and frailty. However, there is little justification for these recommendations. A complicated interrelationship likely exists between traditional diabetes complications, geriatric syndromes, and quality of life. For example, both foot ulcers and falls likely contribute to a worse quality of life; however, foot ulcers may lead to gait instability and a fall, which would lead to lower quality of life. Additionally, there may be subgroups of elderly diabetes patients for whom diabetes complications and geriatric syndromes are especially associated with poor quality of life. Quality of life is also measured by health economists in terms of quantitative values known as health state utility values. The development of utility values for traditional diabetes complications and geriatric syndromes in elderly patients would allow for cost-effectiveness analyses of interventions for these medical problems. Consideration of geriatric syndromes in diabetes patients may alter the traditional approaches to glucose management and overall diabetes care and help providers prioritize care for these complex patients. Specific Aims: 1) To examine the complex interrelationships between geriatric syndromes, traditional diabetes complications, and quality of life; 2) To identify socio-demographic subgroups of elderly diabetes patients at particularly high risk for poor quality of life and to assess the contributions of geriatric syndromes and/or diabetes complications; 3) To quantify health state utility values for specific geriatric syndromes and diabetes- related complications in elderly diabetes patients. These goals will be achieved by a rigorous analysis of existing data of a well-characterized, multi-ethnic cohort of adult patients over 60 years old with diabetes using multiple linear regression modeling and an algorithm-based transformation of quality of life scores for each geriatric syndrome and diabetes complications into health state utility values. This research proposal will fill large gaps in medical knowledge concerning the effects of diabetes on quality of life of elderly adults. Additionally, health state utility values for geriatric syndromes and diabetes complications in elderly diabetes patients will allow for cost-effectiveness analysis of future treatments and programs. The completion of these aims during the course of this fellowship will also be critical for my long-term goals of developing into an investigator in the areas of geriatric diabetes and care prioritization. PUBLIC HEALTH RELEVANCE: Diabetes mellitus disproportionately affects elderly patients and is an expensive complex chronic disease. The elderly diabetes population is heterogeneous and the fastest growing age group of diabetes patients. However, little research exists regarding their care. Determining the factors that affect quality of life in elderly diabetes patients could have wide-ranging clinical implications because of the high prevalence of diabetes in this population. Additionally, understanding the effects of traditional diabetes complications and geriatric syndromes on quality of life could help physicians prioritize the complex medical problems in elderly diabetes patients. The development of utility scores for diabetes complications and geriatric syndromes would allow for cost-effectiveness and cost utility analyses of future treatments and programs.